U.S. Preterm Birth Rate Still Too High: Q&A with Jennifer L. Howse, PhD, the March of Dimes

Nov 12, 2014, 1:15 PM

Last week the March of Dimes releases its annual Premature Birth report card and gave a “C” grade to the United States. While the U.S. rate has seen improvement in recent years and rates of premature birth—which can cause death and lifelong disability—have dropped, the organization says there is still much room for improvement. With World Prematurity Day next week, NewPublicHealth recently spoke with Jennifer L. Howse, PhD, president of the March of Dimes, about the new report card and new efforts by the organization to study premature birth and vastly reduce the U.S. rates further.

NewPublicHealth: What’s most significant about the 2014 report card?

Jennifer Howse: The 2014 report card on premature birth in the United States shows continued improvement. In fact, rates of pre-term birth in the United States have improved. That is they’ve lowered every year for the last seven years and that means that the United States currently has a pre-term birth rate of 11.4 percent, and that rate of pre-term birth is the lowest that it’s been in the in the last 17 years. So we’re very pleased. Having said that, the United States is still short of the target set by the March of Dimes of 9.6 percent or less. Our state-by-state report card assigns a letter grade to the U.S. composite and then to each state up against that goal of 9.6 percent. So, the United States has a “C” overall, but we continue to see progress and improvements—incremental, but progress in far and away the majority of states. So it’s very important around this critical child health issue to set a target, measure the target, and to hold states and the nation accountable.

NPH: What are the things that March of Dimes is doing, has done and will continue to do that are helping that rate?

Howse: The March of Dimes has mobilized a very strong group of partners in this campaign to end premature birth. We have assembled very strong partnerships with clinicians, with state health officials, with hospital leadership, with governmental leaders—particularly in the area of Medicaid programs—and those partnerships have been activated and expanded over the last decade. Specifically, the March of Dimes has led the charge on a quality improvement program across the nation to reduce and eliminate elective induction and C-section before 39 weeks of completed gestation. That’s the QI 39 program, and now two-thirds of hospitals are showing positive results in that arena.

We have worked with our partners to improve and strengthen smoking cessation programs in the United States. We have also worked with our partners to ensure that all women eligible for the administration of progesterone to reduce the risk pre-term birth are indeed signed up for that program. We’re also working with our partners to reform assisted reproductive technology practices so that only single embryo transfer is the normative policy, because there’s a risk of premature birth and other complications with a higher order of births.

I also want to call out our partnership with the Association of State and Territorial Health Officials. These are the ranking state department of health officials in every state and that partnership has been in place for several years now. Bottom line, every state commissioner has signed a pledge to activate in every way possible interventions to reduce the rate of pre-term birth in their states, and they have worked hand in glove—of course—with March of Dimes chapters, with hospitals, with clinical and medical associations in their states. The health commissioners have really done a terrific job of building public awareness and moving forward evidence-based interventions in their respective states, and March of Dimes has created a special group of awards for states that show significant improvement in reducing premature birth rates and also states that achieve that 9.6-or-better national goal.

NPH: Do you think that when a woman becomes pregnant now, is there a better understanding that when that baby is born matters

Howse: Yes, I do. I believe that there’s much more robust consumer education around the issues of timing of delivery. Over the last several years, there’s been an increase of data from studies demonstrating why those last few weeks of pregnancy really matter, and consumer education programs have done a great job of translating that information to moms through their health care providers so that they really do understand that those last weeks of pregnancy count, and they particularly matter in the maturation of the baby’s brain and lungs.

So, I’m optimistic that that educational information will continue to make a difference, and I’m also optimistic, based on the data, that hospital obstetric practices have now been reformed, for the most part, so that early elective deliveries have to all be certified at 39 weeks or more of completed gestation.

NPH: What’s next for the March of Dimes?

Howse: What’s next is that the United States can do better. The United States needs to do better. Reaching the March of Dimes goal of 9.6 percent will still not place the United States in a leadership position among the other high-income countries of the world. In fact, we’re at the lowest tier of the 39 high-income countries that have more than 100,000 births, even though our per capita health investment is the highest in the world. So, the United States can and must do better for its newborns, and to that end, we need to do two things: One, continue the scale-up of all the evidence-based interventions, and two, we need a large investment in new research to identify the precise etiologies of pre-term birth.

We understand probably less than half the reasons why women go into spontaneous labor, so we have mounted a major research investment effort to build a network of five centers across the United States that would focus for the next five years exclusively on understanding the biochemical cascade that triggers labor. It’s a very complicated enterprise, but I believe we’ve blocked and tackled that and broken it into bases and assigned to different areas, it’s sort of like the human genome mapping project where we’ve assigned a map of premature birth across these centers all of which will be named by the end of the year and in full operation beginning in 2015.

So, we’re very excited because we believe this will be a platform for accelerated discovery. It’s a very transparent collaborative network. We intend to share data in real time across other research venues and premature birth because we will have the science that enables us to have the diagnostics and the new treatment and intervention in place.